# JACK H WOLF MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538234208
- **Authorized official:** DR. JACK H WOLF MD (OWNER)
- **Authorized official phone:** (336) 578-3465

## Contact information

- **Practice address:** 236 RIVERBEND RD, GRAHAM, NC 27253
- **Practice address phone:** (336) 578-3465
- **Practice address fax:** (336) 578-3466
- **Mailing address:** 236 RIVERBEND RD, GRAHAM, NC 27253
- **Mailing address phone:** (336) 578-3465
- **Mailing address fax:** (336) 578-3466

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/21/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 89011XU | — | NC |